ABSTRACT

Introduction: Chest trauma is a cause of death in 25% of patients with major systemic trauma. One of the most common pathological phenomena in thoracic trauma is the persistence of intrapleural collections (residual hemothorax). Residual hemothorax ranges from 1-20% of posttraumatic hemothorax. Material and methods: We retrospectively analyzed the records of patients diagnosed with residual hemothorax in a period from January 1, 2015 to June 30, 2017, in order to identify the factors associated with higher hospitalization days, cost and morbidity and mortality which entails the initial management. Results: We reviewed 29 files: the main causes were: 37.9% falls and 31% per knife. 79.3% of the patients were initially treated with thoracic drainage and in 10.3% there was no previous management. All patients had been managed in a second level hospital. Conclusions: It is important to identify the factors that predispose to failure in the management of this pathology and to have the necessary training for the initial resolution in second level hospital units to avoid saturation of hospital services in reference units.

KEYWORDS

Pleural drainage, residual hemothorax, chest trauma, thoracotomy, thoracoscopy.

REFERENCES

1. Andrade-Alegre R, Pérez JG, Ávila A. Toracoscopia rígida en el manejo del hemotórax traumático coagulado. Rev Inst Nal Enf Resp Mex 2005;18(3):195-198.

2. Meyer DM, Jessen ME, Wait MA, Estrera AS. Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Thorac Surg1997;64(5):1396-1400.

3. Morales Uribe CH, Villegas Lanau MI, Petro Sánchez RD. Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax. Surg Endosc 2008;22(1):91-95.

4. Cortes-Telles A, Morales-Villanueva CE, Figueroa-Hurtado E. Hemotórax: etiología, diagnóstico, tratamiento y complicaciones. Rev Biomed 2016;27(3):119-126.

5. Luchette FA, Barrie PS, Oswanski MF, et al. Practice management guidelines for prophylactic antibiotic use in tube thoracostomy for traumatic hemopneumothorax: the EAST Practice Management Guidelines Work Group. Eastern Association for Trauma. J Trauma 2000;48(4):753-757.

6. Hood MR, Boyd AD, Culliford AT. Traumatismos torácicos. Filadelfia: Interamericana-McGraw-Hill; 1982.

7. Burford TH, Parker EF, Samson PC. Early pulmonary decortication in the treatment of postraumatic empyema. Ann Surg 1945;122(2):163-190.

8. Vassiliu P, Velmahos GC, Toutouzas KG. Timing, safety, and efficacy of thoracoscopic evacuation of undrained post-traumatic hemothorax. Am Surg 2001;67(12):1165-1169.

9. DuBose J, Inaba K, Okoye O, et al.; AAST Retained Hemothorax Study Group. Development of posttraumatic empyema in patients with retained hemothorax: results of a prospective, observational AAST study. J Trauma Acute Care Surg 2012;73(3):752-757.

10. Mowery NT, Gunter OL, Collier BR, et al. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma 2011;70(2):510-518. doi: 10.1097/TA.0b013e31820b5c31.

11. Schweigert M, Beron M, Dubecz A, Stadlhuber R, Stein H. Video-assisted thoracoscopic surgery for posttraumatic hemothorax in the very elderly. Thorac Cardiovasc Surg 2012;60(7): 474-479. doi: 10.1055/s-0031-1298069.

12. Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ. Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. Can Respir J 2008;15(5):255-258.

13. Maxwell RA, Campbell DJ, Fabian TC, et al. Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia–a multi-center trial. J Trauma 2004;57(4):742-748.

14. Richardson JD, Carrillo E. Thoracic infection after trauma. Chest Surg Clin N Am 1997;7(2):401-427.

15. de Rezende-Neto JB, Pastore Neto M, Hirano ES, Rizoli S, Nascimento B Jr, Fraga GP. Management of retained hemothoraces after chest tube thoracostomy for trauma. Rev Col Bras Cir 2012;39(4):344-349.

16. Smith JW, Franklin GA, Harbrecht BG, Richardson JD. Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons. J Trauma 2011;71(1):102-105. doi: 10.1097/TA.0b013e3182223080.

17. Dubose J, Inaba K, Demetriades D, et al.; AAST Retained Hemothorax Study Group. Management of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study. J Trauma Acute Care Surg 2012;72(1):11-22. doi: 10.1097/TA.0b013e318242e368.